the dsm-5: a postmodern re-vision for counseling (handout)

The DSM-5: A Postmodern Re-Vision

for Counseling

Education Session

American Counseling Association

Jeffrey T. Guterman, Ph.D.

Clayton V. Martin, M.S.

Sunday, March 15, 2015

8:45 a.m. – 10:15 a.m.

American Counseling Association

2015 Annual Conference

Orlando, Florida

Hyatt Regency, Manatee Spring I & II

Copyright © 2015 by Jeffrey T. Guterman and Clayton V. Martin

The PowerPoint for this Education Session is available at http://JeffreyGuterman.com

http://jeffreyguterman.com/

The DSM-5: A Postmodern Re-Vision for Counseling 2

Contents

About the Presenters ............................................................................................................... 3

Selected Publications by the Presenters .................................................................................. 4

Education Session Description ............................................................................................... 5

Education Session Description ............................................................................................... 5

ACA’s Code of Ethics and Diagnosis ..................................................................................... 6

S.M.A.R.T. Goals for Overcoming Limitations of Diagnosis ................................................ 7

Identifying Exceptions to Limitations of Diagnosis ................................................................ 7

Questions for Amplifying Exceptions to Limitations of Diagnosis ........................................ 7

Outcome Rating Scale (ORS) ................................................................................................. 8

Session Rating Scale (SRS) .................................................................................................... 9

Child Outcome Rating Scale (CORS) ................................................................................... 10

Child Session Rating Scale (CSRS) ...................................................................................... 11

Young Child Outcome Rating Scale (YCORS) .................................................................... 12

Young Child Session Rating Scale (YCSRS) ....................................................................... 13

Suggestions and Considerations for Using Rating Scales and Client Feedback .................. 14

References and Suggested Readings ..................................................................................... 15

Suggested Internet Resources ............................................................................................... 18


About the Presenters

Jeffrey T. Guterman, Ph.D. is a mental health counselor in Fort Lauderdale, Florida. He is

author of over 125 publications. The first edition of his book Mastering the Art of Solution-

Focused Counseling was published by the American Counseling Association (ACA) in 2006,

it was translated in Korean in 2007, and an updated and expanded second edition was

published by ACA in 2013. He has presented numerous workshops on solution-focused

counseling.

Contact Information

Email: [email protected]

Phone: 305-725-4583

Web: http://JeffreyGuterman.com

Twitter: http://twitter.com/JeffreyGuterman

Clayton V. Martin, M.S. is a counselor in Atlanta, Georgia. He has presented workshops on

the topics of strength-based approaches to counseling and LGBTQ advocacy issues in

counseling. He has written articles for counseling journals on solution-focused approaches to

counseling and philosophical issues in counseling. He has extensive clinical experience in

solution-focused counseling with children, adolescents, and young adults in various clinical

settings.

Contact Information

Email: [email protected]

Phone: 404-449-3028

–

Jeffrey T. Guterman, Ph.D. and Clayton V. Martin, M.S. are available to provide training and

workshops for your organization on various topics. Program topics and formats will be

tailored to meet the needs of your organization.


http://twitter.com/JeffreyGuterman


Selected Publications by the Presenters

de Castro, S., & Guterman, J.T. (2008). Solution-focused therapy for families coping with

suicide. Journal of Marital and Family Therapy, 34, 93-106.

Guterman, J. T. (1994). A social constructionist position for mental health counseling.

Journal of Mental Health Counseling, 16, 226-244.

Guterman, J.T. (1996a). Doing mental health counseling: A social constructionist re-vision.


Guterman, J.T. (1996b). Farewell to families: Language systems in the postmodern era. The

Family Journal: Counseling and Therapy for Couples and Families, 4, 139-142.

Guterman, J.T. (1996c). Reconstructing social constructionism: A reply to Albert Ellis.


Guterman, J.T. (1996d). Tales of mental health counseling. Journal of Mental Health

Counseling, 18, 300-306.

Guterman, J.T. (1998). Identifying pretreatment change before the first session. Journal of

Mental Health Counseling, 20, 370-374.

Guterman, J.T. (2013). Mastering the art of solution-focused counseling (2nd

ed.).

Alexandria, VA: American Counseling Association.

Guterman, J.T., & Leite, N. (2006). Solution-focused counseling for clients with religious

and spiritual concerns. Counseling and Values, 51, 39-52.

Guterman, J. T., Martin, C.V., & Kopp, D.M. (2012). Science and humanities: A necessary

unity for the counseling profession. Journal of Humanistic Counseling, 51, 145-154.

Guterman, J.T., & Martin, C.V. (in press). Using puppets with aggressive children to

externalize the problem in narrative therapy. In (A.A. Drewes & C. Schaefer, Eds.),

School age play therapy. Washington, DC: American Psychological Association.

Guterman, J.T., Mecias, A., Ainbinder, D.L. (2005). Solution-focused treatment of migraine

headache. The Family Journal: Counseling and Therapy for Couples and Families,

13, 195-198.

Guterman, J.T., & Schildbach, J. (2014, June). The stigma of mental illness and the noble

savage. Counseling Today, pp. 60-63.

Martin, C.V., Guterman, J.T., & Kopp, D.M. (2012). Extending the dialogue about science

and humanities: A reply to Hansen. Journal of Humanistic Counseling, 51, 161-163.

Martin, C.V., Guterman, J. T., & & Shatz, K. (2012). Solution-focused counseling for eating

disorders. VISTAS, 1-11.


Education Session Description

The DSM-5 is a limiting and stigmatizing diagnostic nosology that offers little to inform

treatment for the complex and unique issues that clients present to counseling. If counselors

intend to function effectively in mental health systems, it is necessary to address the

shortcomings of the DSM-5. In this session, postmodernism is presented as an alternative

framework for counselors to use the DSM-5 in keeping with both their personal values and

defining features of the counseling profession. Postmodernism corresponds to a reaction

against modernist conceptions of certainty, objectivity, and truth. Postmodern conceptual

frameworks are presented for the DSM-5. Various postmodern counseling techniques are

presented to assist clients in overcoming limiting and stigmatizing effects of diagnosis.

Education Session Objectives

1. Identify and review historical developments of mental illness and the DSM-5.

2. Identify and review clinical implications of the DSM-5 from a modernist epistemological

framework.

3. Identify and review postmodern conceptual frameworks as a basis to resolve conflicts

between the DSM-5, and both the personal values of counselors and defining features of the

counseling profession.

4. Identify and review postmodern counseling techniques to assist clients in overcoming

limiting and stigmatizing effects of the DSM-5.


ACA’s Code of Ethics and Diagnosis

Following is the Introduction and a selection of standards from section E of the ACA’s 2014

Code of Ethics.

Introduction (Section E)

Counselors use assessment as one component of the counseling process, taking into account

the clients’ personal and cultural context. Counselors promote the well-being of individual

clients or groups of clients by developing and using appropriate educational, mental health,

psychological, and career assessments.

E.5.a. Proper Diagnosis

Counselors take special care to provide proper diagnosis of mental disorders. Assessment

techniques (including personal interviews) used to determine client care (e.g., locus of

treatment, type of treatment, recommended follow-up) are carefully selected and

appropriately used.

E.5.b. Cultural Sensitivity

Counselors recognize that culture affects the manner in which clients’ problems are defined

and experienced. Clients’ socioeconomic and cultural experiences are considered when

diagnosing mental disorders.

E.5.c. Historical and Social Prejudices in the Diagnosis of Pathology

Counselors recognize historical and social prejudices in the misdiagnosis and pathologizing

of certain individuals and groups and strive to become aware of and address such biases in

themselves or others.

E.5.d. Refraining from Diagnosis

Counselors may refrain from making and/or reporting a diagnosis if they believe that it

would cause harm to the client or others. Counselors carefully consider both the positive and

negative implications of a diagnosis.


S.M.A.R.T. Goals for

Overcoming Limitations of Diagnosis

Specific Goals

Measurable Goals

Achievable Goals

Relevant Goals

Time-based Goals

Identifying Exceptions for

Overcoming Limitations of Diagnosis

Presuppositional questions: Ask, “When has there been a time when _____ (the

problem) has not happened?” or “When has _____ (the goal) happened?” rather than,

“Has there been a time?

Identifying small exceptions

Identifying potential exceptions

o The miracle question:

Suppose that one night there is a miracle and while you are sleeping the

problem . . . is solved: How would you know? What would be different?

(de Shazer, 1988, p. 5)

Questions for Amplifying Exceptions to

Limitations of Diagnosis

How did you make it happen?

How is that different from how you have dealt with the problem in the past?

How did it make your day go differently?

Who else noticed?

What did you tell yourself to make it happen?

What does this say about you and your ability to deal with the depression?

What are the possibilities?


Outcome Rating Scale (ORS)

This scale is for illustration purposes only. The actual scale, which includes 10-centimeter

lines for each item, may be downloaded from http://www.scottdmiller.com. Adapted from

Guterman (2013) and used with permission of Scott D. Miller (http://www.scottdmiller.com).

Name ________________________Age (Years):____ Sex: M / F

Session # ____ Date: ________________________

Who is filling out this form? Please check one: Self_______ Other_______

If other, what is your relationship to this person? ____________________________

Looking back over the last week, including today, help us understand how you have been

feeling by rating how well you have been doing in the following areas of your life, where

marks to the left represent low levels and marks to the right indicate high levels. If you are

filling out this form for another person, please fill out according to how you think he or she

is doing.

ATTENTION CLINICIAN: TO INSURE SCORING ACCURACY PRINT OUT THE

MEASURE TO INSURE THE ITEM LINES ARE 10 CM IN LENGTH. ALTER THE

FORM UNTIL THE LINES PRINT THE CORRECT LENGTH. THEN ERASE THIS

MESSAGE.

Individually

(Personal well-being)

I----------------------------------------------------------------------I

Interpersonally

(Family, close relationships)

I----------------------------------------------------------------------I

Socially

(Work, school, friendships)

I----------------------------------------------------------------------I

Overall

(General sense of well-being)

I----------------------------------------------------------------------I

http://www.scottdmiller.com/



Session Rating Scale (SRS)

This scale is for illustration purposes only. The actual scale, which includes 10-centimeter

lines for each item, may be downloaded from http://www.scottdmiller.com. Adapted from

Guterman (2013) and used with permission of Scott D. Miller (http://www.scottdmiller.com).

Name ________________________Age (Years):____ Sex: M / F

Session # ____ Date: ________________________

Who is filling out this form? Please check one: Self_______ Other_______

If other, what is your relationship to this person? ____________________________

Please rate today’s session by placing a mark on the line nearest to the description that best

fits your experience.

Relationship

I-------------------------------------------------------------------------I

Goals and Topics

I------------------------------------------------------------------------I

Approach or Method

I-------------------------------------------------------------------------I

Overall

I------------------------------------------------------------------------I

I felt heard,

understood, and

respected.

I did not feel

heard,

understood, and

respected.

We worked on

and talked

about what I

wanted to

work on and

talk about.

We did not

work on or

talk about

what I wanted

to work on and

talk about.

Overall,

today’s session

was right for

me.

There was

something

missing in the

session today.

The therapist’s

approach is a

good fit for

me.

The therapist’s

approach is

not a good fit

for me.




Child Outcome Rating Scale (CORS)

This scale is for illustration purposes only. The actual scale may be downloaded from

http://www.scottdmiller.com. Adapted from Guterman (2013) and used with permission of

Scott D. Miller (http://www.scottdmiller.com).

Name ________________________Age (Years):____

Sex: M / F_________

Session # ____ Date: ________________________

Who is filling out this form? Please check one: Child_______ Caretaker_______

If caretaker, what is your relationship to this child? ____________________________

How are you doing? How are things going in your life? Please make a mark on the scale to

let us know. The closer to the smiley face, the better things are. The closer to the frowny

face, things are not so good. If you are a caretaker filling out this form, please fill out

according to how you think the child is doing.

Me

(How am I doing?)

I------------------------------------------------------------------------------------I

Family

(How are things in my family?)

I------------------------------------------------------------------------------------I

School

(How am I doing at school?)

I------------------------------------------------------------------------------------I

Everything (How is everything going?)

I------------------------------------------------------------------------------------I




Child Session Rating Scale (CSRS)




Name ________________________Age (Years):____

Sex: M / F_________

Session # ____ Date: ________________________



How was our time together today? Please put a mark on the lines below to let us know how

you feel.

Listening

I-----------------------------------------------------------------------------------I

How Important

I-----------------------------------------------------------------------------------I

What We Did

I-----------------------------------------------------------------------------------I

Overall

I-----------------------------------------------------------------------------------I

The therapist

listened to me.

The

therapist did

not always

listen to me.

What we did

and talked

about were

important to

me.

What we did

and talked

about was not

really that

important to

me.

I hope we do

the same kind

of things next

time.

I wish we

could do

something

different.

I liked what

we did today.

I did not

like what

we did

today.




Young Child Outcome Rating Scale (YCORS)




Name ________________________Age (Years):____

Sex: M / F_________

Session # ____ Date: ________________________



Choose one of the faces that shows how things are going for you. Or, you can draw one

below that is just right for you.




Young Child Session Rating Scale (YCSRS)




Name ________________________Age (Years):____

Sex: M / F_________

Session # ____ Date: ________________________



Choose one of the faces that shows how things are going for you. Or, you can draw one

below that is just right for you.




Suggestions and Considerations for

Using Rating Scales and Client Feedback

1. Introduce the rating scales to clients by describing their purposes in clear and simple

language.

2. Openly discuss the ratings with clients, and be prepared to take the ratings seriously,

but not personally.

3. Adapt and revise counseling sessions based on the ratings and feedback received from

clients.

4. Adjustments based on rating scales and client feedback may reduce the likelihood of

drop outs and thereby improve treatment outcomes.

5. When clients have difficulty reading or are otherwise unable to understand the rating

scales, especially children, counselors should consider explaining the rating scales to

clients.


References and Suggested Readings

American Counseling Association. (2014). Code of ethics. Alexandria, Virginia: Author.

American Psychiatric Association. (1952). Diagnostic and statistical manual of mental

disorders. Washington, DC: Author.


disorders (2nd

edition). Washington, DC: Author.


disorders (3rd



disorders (3rd

edition, revised). Washington, DC: Author.


disorders (4th



disorders (4th

edition, text revision). Washington, DC: Author.


disorders (5th


Anderson, H., & Goolishian, H.A. (1988). Human systems as linguistic systems: Preliminary

and evolving ideas about the implications for clinical theory. Family Process, 27,

371-393.

Berger, P., & Luckmann, T. (1967). The social construction of reality. Garden City, NY:

Doubleday.

de Shazer, S. (1982). Patterns of brief family therapy. New York: Norton.

de Shazer, S. (1984). The death of resistance. Family Process, 23, 11-17.

de Shazer, S. (1985). Keys to solution in brief therapy. New York: Norton.

de Shazer, S. (1988). Clues: Investigating solutions in brief therapy. New York: Norton.

de Shazer, S. (1991). Putting difference to work. New York: Norton.

de Shazer, S., Berg, I. K., Lipchik, E., Nunnally, E., Molnar E., Gingerich, K., & Weiner-

Davis, M. (1986). Brief therapy: Focused solution development. Family Process, 25,

207-222.

Derrida, J. (1967). Of grammatology (G. C. Spivak, Trans.). Baltimore, MD: The John

Hopkins University Press.

Duncan, B. (2014). On becoming a better therapist: Evidence based practice one client at a

time. (2nd

edition). Washington DC: American Psychological Association

Duncan, B.L., Miller, S., Huggins, A., & Sparks, J. (2003a). Young child outcome rating

scale. Chicago: Author.

Duncan, B.L., Miller, S., Huggins, A., & Sparks, J. (2003b). Young child session rating

scale. Chicago: Author.

Duncan. B.L., Miller, S.D., & Sparks, J. (2003). Child outcome rating scale. Chicago:

Author.

Duncan. B.L., Miller, S.D., & Sparks, J.A. (2004). The heroic client: A revolutionary way to

improve effectiveness through client-directed, outcome-informed therapy. San

Francisco: Jossey-Bass.

Duncan, B.L., Miller, S.D., Sparks, J.A., & Johnson, L.D. (2003). Child session rating scale.

Fort Lauderdale, FL: Author.

El-Hai, J. (2005). The lobotomist: A maverick medical genius and his tragic quest to rid the


world of mental illness. Hoboken, NJ: Wiley & Sons.

Frances, A. (2012, October 30). DSM5 field trials discredit APA. Psychology Today.

Retrieved on February 21, 2015 from https://www.psychologytoday.com/blog/dsm5-

in-distress/201210/dsm-5-field-trials-discredit-apa

Franklin, C., Trepper, T.S., McCollum, E.E., & Gingerich, W.J. (2011). Solution-focused

brief therapy: A handbook of evidence-based practice. New York: Oxford University

Press.

Gergen, K.J. (2009). An invitation to social construction (2nd ed.). Thousand Oaks, CA:

Sage.

Guterman, J. T. (1994). A social constructionist position for mental health counseling.


Guterman, J.T. (1996). Doing mental health counseling: A social constructionist re-vision.


Guterman, J.T. (1998). Identifying pretreatment change before the first session. Journal of

Mental Health Counseling, 20, 370-374.

Guterman, J.T. (2013). Mastering the art of solution-focused counseling (2nd

edition)


Guterman, J.T., & Leite, N. (2006). Solution-focused counseling for clients with religious

and spiritual concerns. Counseling and Values, 51, 39-52.

Guterman, J.T., Mecias, A., Ainbinder, D.L. (2005). Solution-focused treatment of migraine

headache. The Family Journal: Counseling and Therapy for Couples and Families,

13, 195-198.

Guterman, J.T., & Schildbach, J. (2014, June). The stigma of mental illness and the noble

savage. Counseling Today, pp. 60-63.

Held, B.S., (1992). The problem of strategy within the systemic therapies. Journal of Marital

and Family Therapy, 18, 25-35.

Johnson, L.D., Miller, S.D., & Duncan, B.L. (2000). Session rating scale 3.0. Chicago:

Author.

Lambert, M.J. (1992). Implications of outcome research for psychotherapy. In J.C. Norcross

M.R. Goldfried (Eds.), Handbook of psychotherapy integration (pp. 94-129). New

York: Basic Books.

Lambert, M.J., Whipple, J., Smart, D., Vermeersch, D., Nielsen, S., & Hawkins, E. (2001).

The effects of providing therapists with feedback on patient progress during

psychotherapy: Are outcomes enhanced? Psychotherapy Research, 11, 49-46.

Lipchik, E. (2002). Beyond technique in solution-focused therapy: Working with emotions

and the therapeutic relationship. New York: Guilford.

Martin, C.V., Guterman, J. T., & & Shatz, K. (2012). Solution-focused counseling for eating

disorders. VISTAS, 1-11.

Miller, S., & Duncan. B.L. (2000). Outcome rating scale. Chicago: Author.

Molnar A., & de Shazer, S. (1987). Solution-focused therapy: Toward the identification of

therapeutic tasks. Journal of Marital and Family Therapy, 13, 349-358.

Murphy, J.J. (2008). Solution-focused counseling in middle and high schools (2nd

ed.)


O'Hanlon, B., & Rowan, T. (2003). Solution oriented therapy for chronic and severe mental

illness. New York: Norton.

O'Hanlon, W. H., & Weiner-Davis, M. (1989). In search of solutions: A new direction in

https://www.psychologytoday.com/blog/dsm5-in-distress/201210/dsm-5-field-trials-discredit-apa

https://www.psychologytoday.com/blog/dsm5-in-distress/201210/dsm-5-field-trials-discredit-apa


psychotherapy. New York: Norton.

White. M., & Epston, D. (1990). Narrative means to therapeutic ends. New York: Norton.


Suggested Internet Resources

Jeffrey T. Guterman, Ph.D.

PowerPoint for this Institute is available at http://JeffreyGuterman.com

Twitter: http://twitter.com/JeffreyGuterman

Facebook: http://facebook.com/jeffreygutermanpage

Institute for Solution-Focused Therapy

http://www.solutionfocused.net

International Center for Clinical Excellence (ICCE)

http://www.centerforclinicalexcellence.com

National Institute of Mental Health (NIMH): Research Domain Criteria (RDoC)

http://www.nimh.nih.gov/research-priorities/rdoc/index.shtml

Scott D. Miller, Ph.D.

http://www.scottdmiller.com

Solution-Focused Brief Therapy Association (SFBTA)

http://www.sfbta.org


http://twitter.com/JeffreyGuterman

http://facebook.com/jeffreygutermanpage

http://www.solutionfocused.net/

http://www.centerforclinicalexcellence.com/

http://www.nimh.nih.gov/research-priorities/rdoc/index.shtml


http://www.sfbta.org/